Clinical Analysis Of12Cases With Arteriovenous Malformation Of Uterus And Pelvic

Objective the uterus and pelvic arteriovenous malformation (arteriovenous malformations, AVM) is that the uterus and pelvic artery and vein directly communicated by fistula, In this condition, arterial blood with high pressure flows directly into the the vein with low resistance bypassing capillary network It is rarely seen in gynecological clinical practice with the intermittent vaginal bleeding being the main symptoms. Because of the low occurrence rate and few experience, the uterus and pelvic arteriovenous malformation often misdiagnosed as dysfunctional or pregnancy residues, so curettage was given,which may cause uterine bleeding,in severe cases, even deadly hemorrhagic shock. In recent years,along with the slightly rising of occurrence rate, this disease acquired more and more attention. In this study12cases of uterine and pelvic arteriovenous malformation admitted in recent6years were analysis. By summarizing of the commonness and correlation of the risk factors, clinical characteristics, diagnostic and treatment, Rational method of prevention and treatment were explored.Methods Clinical data of12patients with uterine and pelvic arteriovenous malformation hospitalized in Qilu Hospital of Shandong University from2007April to2013January were retrospectively analysed, including the onset age, parity, trauma operation history, clinical manifestations, diagnosis and treatment of patients.Results The age of onset of12patients was from23to57years old with the median age of31years old. the12patients all have uterine trauma history (including cesarean operation, abortion and curettage, delivery and uterine myometomy etc.).1case has the uterine trauma once, and multiple (>=2) uterine trauma histories in11cases. The main clinical symptoms of10patients were irregular vaginal bleeding, while1case is mainly expressed in menorrhagia and menostaxis, and1patient is only feel medial thigh pain.12patients were first checked by the color doppler ultrasound,8cases were confirmed further by CT, CTA or MRI examination of pelvic cavity;6cases were definitely diagnosed by angiography; and there were histopathological evidences in7cases finally. Uterine artery embolization (UAE) was carried out to6patients, with the result of that the clinical symptoms of2cases were eased and3cases were converted to operation treatment, while1case symptom recurred in one year after the treatment of Uterine artery embolization (UAE);8cases were treated successfully by operations, and the drug therapy has played an effective role in control the clinical symptom in1case.Conclusion1. Women of childbearing age is primary group, and multiple uterine operation trauma histories are important predisposing factors.2. Irregular vaginal bleeding were the main clinical symptoms. Therefore, the uterus and pelvic arteriovenous malformation should be considered when the etiology of vaginal bleeding was analysized.3. The diagnosis should deduced by integrating the inducement, symptom and examination methods. Color Doppler ultrasonography should be the preferred screening arteriovenous malformation for diagnosis and follow-up. In the palace or the pelvic cases, pelvic CTA or MRI examination is preoperative indispensable for it’s advantage in definating the extent of disease and relation with surrounding vessels,. Pelvic angiography is still the gold standard of diagnose in the uterine and pelvic arteriovenous malformations.4. The treatment method should be lead by full consideration of the symptoms, range of lesion, age, fertility requirements, systematic disease, et al.. The patients with early diagnosis, no vaginal bleeding symptoms or mild symptoms, can try drug therapy, selective uterine artery embolization has the advantages of saving the ovarian and uterine function, but fail in effectively radical cure and even symptom recurrence. So it is only used for the disease limited to the uterus, young with the wishes to keep the reproductive functio. Completely resection of the lesions and the uterus is the most definitive treatment. It is especially suitable for those with elderly age, no fertility requirements, severe symptoms, poor follow-up conditions, fail in uterine and pelvic arteriovenous malformation embolization or drug treatment..